MIAMI (AP) — State Senate leaders may propose cutting dentistry, optometry and mental health services for Medicaid patients as they try to curb the program’s budget, which is expected to top $21 billion next year.

The emerging Senate bill calls for making cuts in so-called optional services as well as increasing reimbursement rates and limiting legal liabilities for primary care doctors. Although the increased reimbursement rates would cost more, senators want to encourage primary care doctors to continue taking Medicaid patients.

Sen. Joe Negron, R-Stuart, did not specify an amount, but said the reimbursement rate increase would be more than 2 percent. The bill will require patients to make an appointment with a primary care physician within 30 days of signing up for Medicaid.

“We’re only going to be able to fund essential services,” said Negron, who chairs the budget subcommittee that oversees Medicaid. “My goal is that the Medicaid benefit will be comparable to what a citizen in the private sector has, not worse and certainly not better.”

The Senate will release its proposed Medicaid budget next week, and it comes as federal health officials are trying to guide state lawmakers to save money by limiting certain benefits.

Meanwhile, Gov. Rick Scott this week proposed saving $1 billion by reducing Medicaid fees paid to hospitals by 5 percent. But Scott has not released additional details for how he would reduce Medicaid spending. The House’s proposals are still being drafted.

Florida’s Medicaid program for low-income and disabled residents is projected to cost about $20 billion during the current fiscal year, with the federal government footing more than half the bill. The cost is expected to rise to more than $21 billion next fiscal year, which starts July 1. The state is also dealing with a $3.6 billion deficit.

Scott, along with other Republican governors around the country, sent a letter to Health and Human Services Secretary Kathleen Sebelius asking her to tighten the eligibility guidelines so states could cut patients from the Medicaid rolls.

Sebelius said she is reviewing the request and instead urged states to find savings by charging higher co-payments for some services, limiting certain benefits and cracking down on fraud and other improper payments.

Federal health officials estimate that roughly 40 percent, or $100 billion, of all 2008 Medicaid spending nationally was on optional services. They are encouraging states to find savings by limiting optional services that include hospice care, physical therapy and prosthetics.

States have wide discretion in their coverage of optional services. They can eliminate a service or cover it only for targeted groups.

Scott said he’s reviewing Sebelius’ letter, but “doubts that there’s a lot of ways that it’s going to allow us to make a lot of savings.”

Negron also said the Medicaid budget has grown to the “detriment of education,” an assertion that has drawn criticism from health advocates.

“If you start cutting these services that are medically necessary, (patients) can’t find it anywhere else,” said Laura Goodhue, head of the patient advocacy group Florida CHAIN. “That’s something you can’t get somewhere else — dentures to eat or eyeglasses to see in school. They’re trying to make them sound frivolous and like extras but they’re not.”

Scott and lawmakers also agree on expanding a controversial five-county Medicaid privatization program statewide to save money. Critics say the program saved money because for-profit HMOs delivered fewer services. Patients complain they don’t have access to specialists. Several insurance companies dropped out of the program because they couldn’t make a profit, leaving patients to find new doctors and navigate the red tape of another plan.

The Senate bill would penalize providers for pulling out of the program by requiring them to post performance bonds. The House bill will also require them to serve in both rural and urban areas to ensure equal access for patients, Republican Rep. Denise Grimsley said.